Lineage Reprogramming to Induced Cardiac Progenitor Cells (iCPC) By Defined Factors

ABSTRACT

Animal cells, notably adult fibroblasts, are advantageously reprogrammed in direct lineage reprogramming methods using defined factors to produce proliferative and multipotent induced cardiac progenitor cells (iCPC). The iCPC thus produced can be differentiated under suitable differentiation conditions to cardiac lineage cells including cardiomyocytes, smooth muscle cells, and endothelial cells, as evidenced by expression of lineage specific markers. Sets of factors effective in combination to reprogram the fibroblasts can include a set that includes some or all of 5 factors (Mesp1, Baf60c, Nkx2.5, Gata4, Tbx5), a set that includes some or all of 11 factors (Mesp1, Mesp2, Gata4, Gata6, Baf60c, SRF, Isl1, Nkx2.5, Irx4, Tbx5, Tbx20), a set that includes some or all of 18 factors (T, Mesp1, Mesp2, Tbx5, Tbx20, Isl1, Gata4, Gata6, Irx4, Nkx2.5, Hand1, Hand2, Tbx20, Tbx18, Tip60, Baf60c, SRF, Hey2), and a set that includes some or all of 22 factors (T, Mesp1, Mesp2, Tbx5, Tbx20, Isl1, Gata4, Gata6, Irx4, Nkx2.5, Hand1, Hand2, Tbx20, Tbx18, Tip60, Baf60c, SRF, Hey2, Oct4, Klf4, Sox2, L-myc).

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of U.S. Provisional Patent Application No. 61/904,881, filed Nov. 15, 2013; which is incorporated herein by reference as if set forth in its entirety.

STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT

This invention was made with government support under HL099773 awarded by the National Institutes of Health. The government has certain rights in the invention.

BACKGROUND

Several studies have reported reprogramming of animal fibroblasts to induced cardiomyocytes (iCM). However, reprogramming to proliferative and multipotent cardiac progenitor cells (CPC) may be more favorable for cell therapy and research applications for several reasons. iCM have not been shown to be proliferative in culture, thereby limiting the available source of cardiomyocytes (CM) for therapeutic use. Moreover, cardiac cells other than CM might be therapeutically important, but these are not present when iCM are used.

Human pluripotent cells, including human embryonic stem cells (ESC) and human induced pluripotent cells (iPSC), have been differentiated in culture with three soluble factors to produce induced cardiac progenitor cells (iCPC). Cao, et al., “Highly efficient induction and long-term maintenance of multipotent cardiovascular progenitors from human pluripotent stem cells under defined conditions,” Cell Res. 23:1119 (2013). It may be impractical to routinely employ such pluripotent cells as starting material for making therapeutic quantities of iCPC, either because of ethical considerations of using embryonic stem cells, or because of the considerable time and effort required to obtain suitable iPSC. Islas et al, PNAS USA 109:13016-21 (Aug. 7, 2012) (and U.S. Pat. No. 8,486,701) was said to have produced iCPC from human fibroblasts, but the isolated cells did not meet the criteria of proliferation and differentiation into cardiac lineage cells that define cardiac progenitor cells.

Additional approaches are still needed for obtaining proliferative and multipotent iCPC for research or therapeutic use.

BRIEF SUMMARY

A method for producing induced cardiac progenitor cells (iCPC) from mammalian somatic cells includes the steps of:

expressing in the somatic cells a set of factors sufficient to induce reprogramming of the cells to iCPC; and

separating the iCPC from non-reprogrammed somatic cells.

In certain embodiments, the mammalian somatic cells are obtained from a human or from a rodent.

In certain embodiments, the set of factors includes a plurality of early cardiac transcription factors. In some embodiments, the plurality of early cardiac transcription factors includes some or all of Mesp1, Baf60c, Nkx2.5, Gata4, and Tbx5. In other embodiments, the plurality includes some or all of Mesp1, Mesp2, Gata4, Gata6, Baf60c, SRF, Isl1, Nkx2.5, Irx4, Tbx5, and Tbx20. Other pluralities include some or all of T, Mesp1, Mesp2, Tbx5, Tbx20, Isl1, Gata4, Gata6, Irx4, Nkx2.5, Hand1, Hand2, Tbx20, Tbx18, Tip60, Baf60c, SRF, and Hey2. In some embodiments, the factors are encoded by nucleic acid obtained from at least one of a human animal and a non-human animal.

The set of factors can be provided on vectors in an expression library. In some embodiments the vectors are viral (e.g., lentiviral, retroviral, adenoviral, baculoviral) vectors. In other embodiments, the vectors are non-viral vectors such as non-viral episomal vectors, cationic liposomes, neutral liposomes, polymer-nucleic acid complexes (e.g., polymer nanoparticles, dendrimers), and peptide-nucleic acid complexes.

In some embodiments, the expressing step includes the step of exposing the somatic cells to an expression library configured to encode the set of factors. In other embodiments, direct exposure of the cells to the factors per se, and interaction between the cells and the factors may suffice to achieve reprogramming to iCPC. Exposure to every member of the set of factors may not be essential to achieving reprogramming to iCPC.

In some embodiments, the exposing step includes the step of introducing the set of factors into the somatic cells by transfection or other known methods for introduction of genetic material into mammalian somatic cells.

In some embodiments, expression of the set of factors can require induction of expression by exposure of the somatic cells into which the factors were introduced to an inducing agent such as doxycycline in the expression system described herein. The inducing agent can be provided in the culture medium or by any other operable delivery route.

In some embodiments, additional components are advantageously employed in the method to facilitate proliferation of the iCPC. In some embodiments, a suitable component is an activator of canonical Wnt signaling such as 6-bromoindirubin-3′-oxime (BIO). In other embodiments, suitable components include an activator of canonical Wnt signaling and an activator of Jak/Stat signaling such as Leukemia Inhibitory Factor (LIF). In each case the additional component or components are provided in amounts, or at concentrations, sufficient to facilitate proliferation of the iCPC.

In some embodiments, somatic cells to be reprogrammed can be provided with a marker that is selectively expressed only in cells of the desired state, here cells characterized as CPC. In certain embodiments, the somatic cells can contain a stable marker-encoding transgene under control of a CPC-specific regulatory sequence where the transgene produces a detectable product only when the cells are CPC, or in this case induced CPC. A suitable marker-encoding transgene can encode fluorescent protein such as, but not limited to eYFP or eGFP.

In some embodiments, the iCPC can be separated from non-reprogrammed cells by cell sorting on the basis of a cell surface marker characteristic of one cell type or the other, or by another known method for separating cells having distinguishable attributes, including by splitting the cultures such that non-reprogrammed cells, which do not proliferate, are outcompeted by the proliferative, reprogrammed cells. Alternatively, reprogrammed cells can be manually dissected from non-reprogrammed cells on the basis of fluorescence and other morphological differences.

Nucleic acids encoding sets of factors sufficient to reprogram somatic cells to iCPC by direct lineage reprogramming can be provided as kits, as can libraries that include viral or non-viral nucleic acid vectors engineered to express some or all of the encoded factors upon transfer into the somatic mammalian cells.

In another aspect, provided herein is an in vitro population of induced cardiac progenitor cells produced according to a method provided herein.

In a further aspect, provided herein is a culture comprising an in vitro population of induced cardiac progenitor cells produced according to a method provided herein.

These and other features, aspects, and advantages described herein will become better understood upon consideration of the following detailed description, drawings, and appended claims.

BRIEF DESCRIPTION OF THE DRAWINGS

The patent or application file contains at least one drawing executed in color. Copies of this patent or patent application publication with color drawing(s) will be provided by the Office upon request and payment of the necessary fee.

In the descriptions of the drawings and the Examples section below, all work was done with mouse cells unless human is specified.

FIG. 1 depicts a screen for identifying iCPC inducing factors and optimal culture conditions. (A) Schematic representation of experimental design depicting direct reprogramming of iCPCs by defined factors and culture conditions, expansion of iCPCs, and in vitro as well as in vivo differentiation of iCPCs into cardiac-lineage cells. (B) Infection with a combination of 11 cardiac factors induced Nkx2.5-EYFP expression in adult cardiac fibroblasts (AC Fibs) only after dox induction. (C) 11-factor infected AC Fibs developed into two dimensional, proliferative colonies of EYFP+ cells. Images taken 3 weeks after dox treatment show a colony of reprogrammed EYFP+ cells, surrounded by EYFP-fibroblasts. (D) Images show the striking morphological difference between EYFP+ reprogrammed cells and EYFP-fibroblasts (indicated by *). Reprogrammed cells lost parental fibroblast morphology and exhibited a high nuclear-cytoplasmic ratio. (E) Strategy to test impact of culture conditions on F11 reprogramming efficiency as well as the ability of EYFP+ reprogrammed cells to maintain a proliferative state. (F) Number of EYFP+ colonies formed (per 50,000 starting cells) in the respective culture conditions (**p<0.01, *p<0.05). (G) Impact of culture conditions on EYFP+ colonies expanded up to 5 passages scoring for EYFP+ expression and proliferative ability (Dox only: n=8, Dox+LIF: n=3, Dox+BIO: n=4, Dox+LIF+BIO: n=9). (L=LIF, B=BIO). Data presented as mean. Error bars=SEM. Scale bar=100 μm in B, 500 μm in C and D.

FIG. 2 depicts the vectors used in creation of a lentiviral expression library that includes various agents and factors associated with cardiogenesis.

FIG. 3 depicts a screen for iCPC inducing factors and culture conditions. (A) Uninfected AC Fibs showed no EYFP expression. (B) AC Fibs infected with iPS factors (Klf4, Oct4, L-myc, Sox2) showed proliferative cells that formed iPS-like colonies which were EYFP-(3 weeks after adding dox). (C) Neonatal cardiac fibroblasts infected with Gata4, Mef2c, Tbx5 (iCM factors) showed spontaneous beating 25 days after dox treatment. Arrows indicate induced cardiomyocytes (iCMs). iCMs did not show EYFP expression. (D) AC Fibs infected with combinations of either 22 factors or 18 factors developed into EYFP+ cells 3 weeks after dox induction. (E) AC Fibs infected with an eleven-factor set and induced by exposure to dox develop proliferative EYFP+ colonies; however, upon expansion in dox only culture condition these cells lost EYFP expression and senesced within 3-5 passages. (F) Addition of BIO resulted in expandable EYFP+ cells. However, they became spindle-shaped and were not highly proliferative. (G) Addition of both LIF and BIO produced the brightest EYFP+ cells which were robustly expandable. Scale bar represents 100 μm in A-D and 200 μm in E-G.

FIG. 4 presents gene ontology analysis performed for upregulated and downregulated genes in late passage iCPCs as compared to AC Fibs.

FIG. 5 depicts eleven factors that in combination stably reprogram adult cardiac fibroblasts into proliferative iCPCs. (A) iCPCs maintained EYFP expression and proliferative ability for at least 30 passages after dox withdrawal. (B) Population doubling time for passage 10 (P10) and passage 20 (P20) iCPCs as compared to uninfected AC Fibs. Data represented as mean (n=3). (C) qPCR analysis showed upregulation of CPC markers and downregulation of fibroblast markers. Data represent normalized fold expression relative to uninfected AC Fibs (*p<0.01, #p<0.05). (D) Immunofluorescence labeling of iCPCs showed nuclear localization of TFs Nkx2.5, Gata4, and Irx4 and flow cytometry analysis revealed that almost all of iCPCs expressed these TFs (E). (F) Flow cytometry analyses showed that iCPCs expressed cell surface makers such as Cxcr4, Flk1, Pdgfr-α, cKit that are associated with CPCs (n=3). Error bars=SEM. Scale bars=200 μm.

FIG. 6 demonstrates that iCPCs are multipotent and differentiate into contracting cardiomyocytes, smooth muscle cells, and endothelial cells in vitro. (A) iCPCs aggregated in cardiac differentiation medium were YFP+ at day 2 (B) iCPC aggregates were plated and cultured in low serum conditions and lost Nkx2.5-EYFP expression by day 20. (C) Immunocytochemistry on plated cells revealed expression of CM markers such as cardiac actin, α-actinin (note highly organized sarcomere staining), MLC-2a, MLC-2v, α/β MHC, a SM marker SM-MHC and EC marker CD31. (D) iCPC-CMs infected with a GFP expressing lentivirus co-cultured with mESC-CMs that expressed td-tomato. No cell fusion was detected. (E) Cx43 immunolabeling showed that iCPC CMs developed gap junctions with mESC-CMs and other iCPC-CMs. (F) iCPC-CMs showed synchronous calcium transients with mESC-CMs 3 weeks after co-culture. White arrow=iCPC-CM, yellow arrow=mESC-CM. (G) Quantification of calcium transients. Scale bars=400 μm in A & B, 100 μm in C, 200 μm in D, 50 μm in E, 10 μm in F, 1 second in G.

FIG. 7 depicts the differentiation of mouse iCPCs into functional cardiomyocytes ex vivo. (A) Shows the number of embryos injected with iCPCs and the location of iCPC-derived cells 24 or 48 hrs after whole embryo culture. (B) iCPCs (labeled with GFP expressing lentivirus) injected into the cardiac crescent of mouse embryos colonized the developing heart tube as assessed after 24 hrs of whole embryo culture. (C) Histological sections of iCPC injected embryos were stained for GFP antibody (dark brown color). iCPC-derived cells (brown arrows) integrated with host cell in the developing heart tube. (D) 24-hr cultured embryos were immunostained in whole mount preparations for CM markers and GFP. 3D reconstruction images show iCPCs differentiated into CMs, as indicated by co-expression of CM markers and GFP. (E) iCPC-CMs matured ex vivo after extended culture period (48 hours) and attained shape/size similar to native CMs.

FIG. 8 depicts five factors that in combination stably reprogram adult cardiac fibroblasts into proliferative and multipotent iCPCs. (A) Factor combinations tested both for ability to produce Nkx2.5-EYFP+ colonies and to expand them for at least 5 passages without dox. [MTG (n=3), MTGN (n=5), MTGNB (n=5)] (B) Number of EYFP+ colonies produced after infection with 5 factors and culture in iCPC induction medium for 3 weeks (per 50,000 seeded cells). (L=LIF, B=BIO) (C) EYFP+ cells reprogrammed using 5 factors could be stably expanded without dox. (D) Immunolabeling of 5 factor iCPCs showed nuclear localization of TFs Nkx2.5, Gata4, and Irx4, quantified by flow cytometry analysis in (E). (F) 5 factor iCPCs expressed surface markers associated with CPCs as shown by flow cytometery analysis (n=2). (G) iCPCs reprogrammed with 5 factors were multipotent and could be differentiated into CMs (cardiac actin, α-actinin, MLC-2a, MLC-2v, α/β MHC), SMs (SM-MHC) and ECs (CD 31). Note highly organized sarcomere staining for α-actinin. Data presented as mean, error bars=SEM. Scale bars=100 μm.

FIG. 9 depicts combinations of cardiac factors that stably reprogram adult mouse lung fibroblasts into proliferative and multipotent iCPCs. (A) Number of Nkx2.5-EYFP+ colonies produced (per 50,000 seeded cells) after infection of adult lung fibroblasts with 11 or 5 factors and culture in iCPC induction medium for 3 weeks (n=4). (L=LIF, B=BIO) (B) EYFP+ cells reprogrammed using a set of 5 factors were stably expanded without dox shown after 10 passages. (C) Immunolabeling revealed lung-iCPCs had nuclear localization of CPC TFs, quantified in (D). (E & F) Flow cytometery analysis revealed that Lung-iCPCs expressed cell surface markers associated with CPCs (n=3). (G) Lung-iPSCs were multipotent and differentiated into CMs (cardiac actin, α-actinin, MLC-2a, MLC-2v, α/β MHC), SMs (SMMHC) and ECs (CD31). Note highly organized sarcomere staining for α-actinin. Data presented as mean, error bars=SEM. Scale bars=100 μm.

FIG. 10 depicts cardiac factors that stably reprogram adult mouse tail-tip fibroblasts into proliferative and multipotent iCPCs. (A) Number of Nkx2.5-EYFP+ colonies produced after infection of adult tail-tip fibroblasts with 11 or 5 factors (n=4). (B) EYFP+ cells reprogrammed using 5 factors could be stably expanded without dox. (C) Tail-tip-iCPCs expressed TFs associated with CPCs. (D) Tail-tip-iCPCs expressed cell surface markers associated with CPCs (n=3). (E) Tail-tip-iCPCs were multipotent and differentiated into cardiomyocytes (cardiac actin, α-actinin, MLC-2a, MLC-2v, α/β MHC), smooth muscle cells (SM-MHC) and endothelial cells (CD 31). Note highly organized sarcomere staining for α-actinin. Data presented as mean, error bars indicate standard error of mean. Data presented as mean, error bars=SEM. Scale bars represent 100 μm.

FIG. 11 depicts stable reprogramming of genetically unmodified human fibroblasts into proliferative and multipotent iCPCs by 11 cardiac factors. (A-B) Phase contrast images show human fibroblasts before (A) and 24 hours after (B) dox induction of cells infected with dox-inducible GFP lentivirus+11-factor set. GFP fluorescence was observed only after dox induction. (C) Proliferative and morphologically distinct cells are visible 2 weeks after dox induction. (D) By day 24, these cells developed into colonies of highly proliferative cells.

FIG. 12 depicts (A) immunolabeling of 11-factor human iCPCs, showing nuclear localization of TFs Tbx5, Nkx2.5, Mesp1, and Irx4. (B) Immunolabeling of human cardiomyocytes differentiated from human iCPCs, showing expression of cardiac actin, MLC-2a, α-actinin, MLC-2v, α-MHC, SM-MHC (marker of smooth muscle cells), and CD31 (marker of endothelial cells).

FIG. 13 presents defined factors used for iCPC reprogramming screen.

DETAILED DESCRIPTION

All publications, patents, and patent applications mentioned in this specification are herein incorporated by reference in their entirety as if each individual publication, patent, and patent application was specifically and individually indicated to be incorporated by reference.

Several studies have reported reprogramming of fibroblasts to induced cardiomyocytes. However, reprogramming to proliferative induced cardiac progenitor cells (iCPCs), which are favorable for cardiac repair because of their expandability and multipotency, had not been accomplished prior to the Inventors' discovery. Described for the first time, therefore, are methods for producing a scalable source of clinically relevant cardiac lineage progenitor cells useful for numerous applications including cardiac regenerative therapy, drug discovery, and disease modeling. Lineage reprogramming of adult somatic cells into iCPCs provides a scalable cell source for cardiac regenerative therapy, drug discovery, and disease modeling. Accordingly, the present invention is based at least in part on the Inventors' discovery of defined factors capable of stably reprogramming somatic cells to cardiac lineage-restricted progenitors that can be extensively passaged and expanded in culture and that show multipotency toward cardiovascular lineages. Also provided herein are novel methods for reprogramming differentiated somatic cells into expandable populations of multipotent cardiac progenitor cells.

In a first aspect, provided herein are methods for producing induced cardiac progenitor cells (iCPCs) from somatic cells. In exemplary embodiments the method includes expressing in the somatic cells a set of factors sufficient to induce reprogramming of the cells to produce iCPC; and separating the iCPC from non-reprogrammed cells. As used herein, the terms “induced cardiac progenitor cell” and “iCPC” refer to proliferative and expandable progenitor cells that maintain multipotency to differentiate into cardiomyocytes, smooth muscle cells, and endothelial cells. As used herein, the term “proliferative” refers to the capacity of a iCPC to increase in cell number in culture and give rise to more progenitor cells having the ability to generate a large number of mother cells. Proliferative cardiac progenitor cells are identifiable based on some or all of the following properties: actively cycling; capable of self-renewal; pre-mitotic arrest; able to differentiate into terminally derived cardiac cell types (e.g., functional cardiomyocytes); express markers (e.g., biomarkers) characteristic of cardiac progenitor cells such as, without limitation, transcription factors Mesp1, Nkx2.5, GATA4, Mef2C, Irx4, TBX5, TBX20, Isl1, SRF as well cell surface markers CXCR4, PDGFRa, c-Kit, Flk-1, and Sca-1. iCPCs can be obtained by reprogramming various differentiated (i.e., non-pluripotent and multipotent) somatic cells. Apart from genetic material introduced to encode the factors, the reprogrammed (i.e., converted) cells are substantially genetically identical to the somatic cells from which they were derived. Preferably, the differentiated somatic cell is a mammalian somatic cell. More preferably, a mammalian somatic cell is from a human or a rodent.

As used herein, the term “reprogramming” refers to a genetic process whereby differentiated somatic cells are converted into multipotent cells having a greater multipotency potential than the cells from which they were derived. Likewise, the term “reprogramming factor” refers to a factor, such as a gene or other nucleic acid, or a functional fragment thereof, as well as an encoded factor or functional fragment thereof, which have the capacity to reprogram, transform, or enhance the potency of a somatic cell, so that it becomes a proliferative and expandable multipotent progenitor cell. In exemplary embodiments, a method as described herein results in direct lineage reprogramming which, as used herein, means that an iCPC is obtained from a differentiated somatic cell without the somatic cells into which reprogramming factors are introduced passing through a pluripotent cell stage.

In some cases, the reprogramming factors are early cardiac transcription factors. The factors can include, without limitation, Mesp1, Baf60c, Nkx2.5, Gata4, and Tbx5. In some cases, factors are introduced as a set of factors comprising a plurality of early cardiac transcription factors (TFs). The plurality can comprise some of all of Mesp1, Baf60c, Nkx2.5, Gata4, and Tbx5. In some cases, the plurality of early cardiac transcription factors includes some or all of Mesp1, Mesp2, Gata4, Gata6, Baf60c, SRF, Isl1, Nkx2.5, Irx4, Tbx5, and Tbx20. In other cases, the plurality includes some or all of T, Mesp1, Mesp2, Tbx5, Tbx20, Isl1, Gata4, Gata6, Irx4, Nkx2.5, Hand1, Hand2, Tbx20, Tbx18, Tip60, Baf60c, SRF, and Hey2. In some cases, the set of factors further comprises at least one chromatin remodeling factor. In some embodiments, as few as five factors are sufficient. For example, a set of factors can comprise Mesp1, Baf60c, Nkx2.5, Gata4, and Tbx5.

In some cases, the plurality of factors comprises one or more artificial transcription factors (ATFs). ATFs resemble naturally occurring transcription factors and generally comprise a DNA-binding domain that can recognize a specific DNA sequence (typically near the transcription start site of a targeted gene) and an effector domain that mediates transcriptional activation or repression. In some cases, the effector domain is an activator of transcription such as, for example, herpes simplex virus VP16, VP64, or nuclear factor-KB subunit p65.

Reprogramming factors optionally can be present only transiently in the reprogrammed cells or can be maintained in a transcriptionally active or inactive state in the genome of the reprogrammed cells. Likewise, the reprogramming factors can be present in more than one copy in the induced cardiac progenitor cells, where the factor can be integrated in the cell's genome, can be extra-chromosomal, or both. Preferably, the factors are encoded by nucleic acid obtained from a human animal or a non-human animal.

Suitable somatic cells can be any somatic cell such as a non-embryonic cell obtained from a fetal, newborn, juvenile or adult mammal, including a human. Differentiated somatic cells, including cells from a fetal, newborn, juvenile or adult mammal, including human, individual, are suitable starting cells in the methods. Suitable somatic cells include, but are not limited to, bone marrow cells, epithelial cells, endothelial cells, fibroblast cells, hematopoietic cells, keratinocytes, hepatic cells, intestinal cells, mesenchymal cells, myeloid precursor cells and spleen cells. Suitable somatic cells are receptive, or can be made receptive using methods generally known in the scientific literature, to uptake of reprogramming factors including genetic material encoding the factors. Uptake-enhancing methods can vary depending on the cell type and expression system. Exemplary conditions used to prepare receptive somatic cells having suitable transduction efficiency are well-known by those of ordinary skill in the art. The starting somatic cells can have a doubling time of about twenty-four hours.

A method for producing a proliferative and expandable cardiac progenitor cell as described herein includes a introducing step in which a set of factors are introduced into somatic cells by transfection or other known methods for introduction of genetic material into mammalian somatic cells. In some cases, a set of factors is introduced into a mammalian somatic cell as a vector or construct encoding the set of factors. As used herein, the terms “construct” and “vector” refer to a recombinant nucleotide sequence, generally a recombinant DNA molecule, that has been generated for the purpose of the expression of a specific nucleotide sequence(s), or is used in the construction of other recombinant nucleotide sequences. In general, the terms “vector” and “construct” are used herein to refer to a recombinant DNA molecule or, in some cases, a nucleic acid/polymer complex or nucleic acid/peptide complex. The terms “plasmid” and “vector” as used herein include autonomously replicating nucleotide sequences as well as genome integrating nucleotide sequences.

In exemplary embodiments, a set of factors is introduced using a vector, where the vector includes an expression construct comprising a promoter operably linked to a nucleotide sequence encoding inducing factor under the transcriptional control of the regulatable promoter. As used herein, the term “operably linked” refers to a DNA sequence and a regulatory sequence(s) are connected in such a way as to permit gene expression when the appropriate molecules (e.g., transcriptional activator proteins) are bound to the regulatory sequence(s). In preferred cases, the operably linked promoter is not natively associated with the coding sequence of a reprogramming factor. In some cases, introducing comprises direct exposure of a somatic cell to the factors per se, whereby an interaction between the cells and the factors is sufficient to achieve reprogramming of the somatic cell to iCPC. Exposure to every member of the set of factors may not be essential to achieving reprogramming to iCPC.

Vectors suitable for use according to the methods described herein include, without limitation, non-viral vectors such as non-viral episomal vectors. As used herein, the terms “non-viral vector” and “non-viral construct” are used interchangably and mean that the vector or construct cannot encode an infectious virus. Episomal vectors include structural components that permit the vector to self-replicate in the somatic starting cells. For example, the known Epstein Barr oriP/Nuclear Antigen-1 (EBNA-I) combination (see, e.g., Linder et al., Plasmid 58:1 (2007), incorporated by reference as if set forth herein in its entirety) is sufficient to support vector self-replication and other combinations known to function in mammalian, particularly primate, cells can also be employed. Preferably, vectors suitable for use according to the methods described herein can be propagated and expressed episomally in human cells. Standard techniques for the construction of non-viral vectors suitable for use in the present invention are well-known to one of ordinary skill in the art and can be found in publications such as Sambrook J, et al., “Molecular cloning: a laboratory manual,” (3rd ed. Cold Spring harbor Press, Cold Spring Harbor, N.Y. 2001), incorporated herein by reference as if set forth in its entirety. In exemplary embodiments, suitable expression cassettes structures are created using conventional methods by direct polymerase chain reaction (PCR) amplification of open reading frames (ORFs) from some or all of a set of reprogramming factors. Other non-viral vectors suitable for use according to the methods provided herein include, without limitation, In other embodiments, the vectors are non-viral vectors such as non-viral episomal vectors, cationic liposomes, neutral liposomes, polymer-nucleic acid complexes (e.g., polymer nanoparticles, dendrimers), and peptide-nucleic acid complexes.

In some cases, vectors useful for the methods provided herein include viral vectors, most commonly adenoviral and retroviral vectors. Exemplary viral-based vectors include, but are not limited to, recombinant retroviruses (see, e.g., WO 90/07936; WO 94/03622; WO 93/25698; WO 93/25234; U.S. Pat. No. 5,219,740; WO 93/11230; WO 93/10218; U.S. Pat. No. 4,777,127; GB Patent No. 2,200,651; EP 0 345 242; and WO 91/02805); alphavirus-based vectors (e.g., Sindbis virus vectors, Semliki forest virus (ATCC VR-67; ATCC VR-1247); and adeno-associated virus (AAV) vectors (see, e.g., WO 94/12649, WO 93/03769; WO 93/19191; WO 94/28938; WO 95/11984 and WO 95/00655).

Suitable reprogramming vectors are episomal vectors, such as plasmids, that do not encode all or part of a viral genome sufficient to give rise to an infectious or replication-competent virus, although the vectors can contain structural elements obtained from one or more virus.

One or a plurality of reprogramming vectors can be introduced into a single somatic cell. One or more transgenes can be provided on a single reprogramming vector. One strong, constitutive transcriptional promoter can provide transcriptional control for a plurality of transgenes, which can be provided as an expression cassette. Separate expression cassettes on a vector can be under the transcriptional control of separate strong, constitutive promoters, which can be copies of the same promoter or can be distinct promoters. Various heterologous promoters are known in the art and can be used depending on factors such as the desired expression level of the potency-determining factor. It can be advantageous to control transcription of separate expression cassettes using distinct promoters having distinct strengths in the target somatic cells. In human somatic cells, both the human EF 1a elongation factor promoter (EF 1a) and CMV are strong promoters, but the cytomegalovirus (CMV) immediate early promoter is silenced more efficiently than the EF1α promoter such that expression of transgenes under control of the former is turned off sooner than that of transgenes under control of the latter. Preferably, where a plurality of transgenes is encoded on a single transcript, an internal ribosome entry site is provided upstream of transgene(s) distal from the transcriptional promoter. Although the relative ratio of factors can vary depending upon the factors delivered, one of ordinary skill in possession of this disclosure can determine an optimal ratio of factors.

The skilled artisan will appreciate that the advantageous efficiency of introducing all factors via a single vector rather than via a plurality of vectors, but that as total vector size increases, it becomes increasingly difficult to introduce the vector. The skilled artisan will also appreciate that position of a factor on a vector can affect its temporal expression, and the resulting reprogramming efficiency. After introduction of the reprogramming vectors, and while the somatic cells are being reprogrammed, the vectors can persist in target cells while the introduced transgenes are transcribed and translated. Transgene expression can be advantageously downregulated or turned off in cells that have been reprogrammed to a pluripotent state. The reprogramming vector(s) can remain extra-chromosomal.

In an exemplary embodiment, an expression construct or vector suitable for use according to the methods provided herein comprise at least one regulatory sequence or control sequence. As used herein, a “regulatory sequence” or “control sequence” is a nucleotide sequence involved in an interaction of molecules that contributes to the functional regulation of a polynucleotide, such as replication, duplication, transcription, splicing, polyadenylation, translation, or degradation of the polynucleotide. Transcriptional control elements include promoter regions, polyadenylation signals, transcription termination sequences, upstream regulatory domains, origins of replication, internal ribosome entry sites (“IRES”), enhancers, splice junctions, and the like, which collectively provide for the replication, transcription, post-transcriptional processing and translation of a coding sequence in a recipient cell. In some cases, an expression vector comprises a regulatable (e.g., inducible) promoter. Control of expression of reprogramming factors can be achieved by contacting a somatic cell having at least one reprogramming factor under the control of an inducible promoter with a regulatory agent or other inducing agent. In such cases, a set of factors is introduced to a somatic cell using an expression construct comprising a regulatable promoter operably linked to at least one polynucleotide sequence encoding one or more reprogramming factors. Inducible gene expression is obtained by virtue of the presence or absence of an inducer. Several inducible promoter systems have been described including those controlled by hormones (e.g., estrogen), RU-486 (a progesterone antagonist) (Wang et al. 1994 Proc. Natl. Acad. Sci. USA 91:8180-8184), steroids (Mader and White, 1993 Proc. Natl. Acad. Sci. USA 90:5603-5607), and tetracycline (Gossen and Bujard 1992 Proc. Natl. Acad. Sci. USA 89:5547-5551; U.S. Pat. No. 5,464,758). In exemplary embodiments, expression of the set of factors is induced in the presence or absence of a tetracycline or doxycycline (dox) inducing agent. Dox is a derivative of the antibiotic tetracycline. When a tetracyline-controlled inducible system is used, transcription is reversibly turned on or off in the presence of tetracycline or dox. A “Tet-Off” inducible system activates expression in the absence of tetracycline and its derivatives (e.g., Dox), whereas a “Tet-On” system activates in the presence of tetracycline and its derivatives. In exemplary embodiments, a method provided herein comprises contacting a somatic cell to an iCPC induction medium that comprises an inducing agent.

In exemplary embodiments, the methods provided herein further comprise a step in which iCPCs produced according to a method provided herein are maintained in a proliferative state. In some cases, an iCPC maintenance medium comprises an iCPC induction medium lacking an inducing agent (e.g., dox). In other cases, iCPCs produced according to a method provided herein are maintained in a proliferative state by culturing the cells in a medium that comprises an activator of canonical Wnt signaling and, optionally, an activator of Jak/Stat signaling, each in an amount sufficient to maintain proliferating iCPC. For example, a culture medium for maintaining proliferative iCPCs comprises an activator of canonical Wnt signaling and an activator of Jak/Stat signaling. Appropriate activators of canonical Wnt signaling include, without limitation, 6-bromoindirubin-3′-oxime (BIO), CHIR 99021, CHIR 98014, and BIO-acetoxime, LiCl, SB 216763, SB415286, AR A014418, 1-Azakenpaullone, and Bis-7-indolylmaleimide. Activators of Jak/Stat signaling useful for the methods described herein include Interleukin (IL)-6-related cytokines such as Leukemia Inhibitory Factor (LIF), IL-2, IL-6, IL-11, leptin, and ciliary neurotrophic factor (CNTF). In some cases, a culture medium for maintaining proliferative iCPCs comprises BIO as the activator of canonical Wnt signaling and LIF as the activator of Jak/Stat signaling. In exemplary embodiments, maintained iCPCs are separated from non-reprogrammed cells by cell sorting, splitting, manual dissection, or a combination thereof.

A somatic cell can have a heterologous sequence for inducing expression of nucleic acids encoding the set of factors, whereby the step of expressing a set of factors comprises inducing gene expression by virtue of the presence or absence of an inducer.

In some cases, a somatic cell alternatively or additionally comprises a heterologous sequence encoding a non-lethal marker that is expressed only in cells at a developmental stage characteristic of a cardiac progenitor cell. Non-lethal markers include, without limitation, fluorescent markers such as Green Fluorescent Protein (GFP), Enhanced Green Fluorescent Protein (EGFP), and luciferase. A selectable marker gene can be used to identify the reprogrammed cells expressing the marker through visible cell selection techniques, such as fluorescent cell sorting techniques. In such cases, the expressing step comprises inducing the expression such that the cell is reprogrammed to produce the iCPC, such that the non-lethal, selectable marker indicates the presence of a cell at the developmental stage characteristic of cardiac progenitor cells. It is not intended that all cells in the reprogrammed cell culture have the desired level of potency. Given the inefficiencies of cell sorting technology, the variations in levels of gene expression and other biological effects, some cells in the enriched population may not be multipotent induced cardiac progenitor cells. However, at a practical level, the reprogrammed cell population derived from somatic cells is enriched for induced cardiac progenitor cells having multipotency to differentiate into cardiomyocytes, smooth muscle cells, and endothelial cells.

Induced CPCs can be identified using any appropriate method such as, for example, detecting nuclear localization of cardiac progenitor cell transcription factors (TFs) (e.g., Irx4, Gata4, Nkx2.5) or detecting expression of CPC-associated cell surface markers (e.g., Cxcr4, Flk1, Pdgfr-α, cKit). Importantly, iCPCs also can be identified under these culture conditions based on morphology and in the absence of a detectable reporter (i.e., for use in vivo).

It can be advantageous to separate iCPCs from non-reprogrammed cells. Any appropriate cell separating or cell sorting method can be used according to a method provided herein. Procedures for separation of iCPCs can include magnetic separation, using antibody coated magnetic beads, affinity chromatography, and “panning” with antibody attached to a solid matrix, e.g., plate, or other convenient technique. Techniques providing accurate separation include fluorescence activated cell sorting, which can have varying degrees of sophistication, e.g., a plurality of color channels, low angle and obtuse light scattering detecting channels, impedance channels, etc. Cells can be sorted on the basis of a cell surface marker characteristic of cardiac progenitor cells or other cell type. Other methods for separating cells based on the distinguishable attribute(s) of the target cell include separating non-proliferative reprogrammed cells by splitting the cultures such that non-reprogrammed cells, which do not proliferate, are outcompeted by the proliferative, reprogrammed cells. Alternatively, reprogrammed cells can be manually or mechanically dissected from non-reprogrammed cells on the basis of fluorescence or other morphological differences.

Induced cardiac progenitor cells obtained according to a method provided herein can be cultured in any medium used to support growth of cardiac progenitor cells. For example, a culture medium can include DMEM, 10% FBS 1% NEAA, 1% L-glutamine, and 1% Pen/strep. Other appropriate culture media include, without limitation, a defined medium, such as TeSR™ (StemCell Technologies, Inc.; Vancouver, Canada), mTeSR™ (StemCell Technologies, Inc.) and StemLine® serum-free medium (Sigma; St. Louis, Mo.), as well as conditioned medium. As used herein, a “defined medium” refers to a biochemically defined formulation comprised solely of biochemically-defined constituents. A defined medium may also include solely constituents having known chemical compositions. A defined medium may further include constituents derived from known sources. As used herein, “conditioned medium” refers to a growth medium that is further supplemented with soluble factors from cells cultured in the medium.

Induced cardiac progenitor cells obtained according to the methods described herein are advantageous for a variety of biomedical and clinical applications including, without limitation, basic biomedical research (e.g., cardiac development, cardiac cell biology and physiology), modeling cardiac diseases, drug discovery and toxicology, and cardiac regenerative therapies. With respect to regenerative therapies, induced cardiac progenitors as described herein are less tumorigenic than pluripotent stem cell derivatives, provide a scalable cell source, and differentiation can be directed to obtain cardiomyocytes, smooth muscle cells, and endothelial cells.

Although the invention has been described in considerable detail with reference to certain embodiments, one skilled in the art will appreciate that the present invention can be practiced by other than the described embodiments, which have been presented for purposes of illustration and not of limitation. Therefore, the scope of the appended claims should not be limited to the description of the embodiments contained herein.

EXAMPLES Example 1—Defined Factor Libraries

A nucleic acid Gateway entry library encoding transcription factors and chromatin remodeling agents involved in normal cardiogenesis as well as factors involved in reprogramming of somatic cells to pluripotency was generated by individually cloning the nucleic acid coding sequence of each gene into Gateway entry vector pCRTM8/GW/TOPO® (Invitrogen) to produce a Gateway entry library. A minimal Kozak sequence (ACC) was added upstream of ATG whenever possible. The Gateway entry library was then transferred into a doxycycline-inducible, Gateway-adapted lentivirus destination vector (pSAM, see, U.S. Patent Publication Number 2007/0243608, incorporated herein by reference as if set forth in its entirety) using site specific recombination mediated by LR Clonase II™ (Invitrogen) to create a lentivirus destination vector (FIG. 2 ) that was sequence verified.

In various iterations, subsets of such lentivirus destination vectors separately encoding various combinatorial sets of factors were combined and were included in the various lentivirus expression libraries thus produced. The sets of factors represented in the libraries were as follows:

Factor Combinations

Set of 22 factors: T, Mesp1, Mesp2, Tbx5, Tbx20, Isl1, Gata4, Gata6, Irx4, Nkx2.5, Hand1, Hand2, Tbx20, Tbx18, Tip60, Baf60c, SRF, Hey2, Oct4, Klf4, Sox2, L-myc. Set of 18 factors: T, Mesp1, Mesp2, Tbx5, Tbx20, Isl1, Gata4, Gata6, Irx4, Nkx2.5, Hand1, Hand2, Tbx20, Tbx18, Tip60, Baf60c, SRF, Hey2.

Set of 11 Factors: Mesp1, Mesp2, Gata4, Gata6, Baf60c, SRF, Isl1, Nkx2.5, Irx4, Tbx5, Tbx20.

Set of 6 Factors: Mesp1, Baf60c, Nkx2.5, Gata4, Tbx5, Oct4. (In addition to being an iPSC reprogramming factor, Oct4 has a role in development of CPC as well, so it was included in this set.)

Set of 5 Factors: Mesp1, Baf60c, Nkx2.5, Gata4, Tbx5

Instead of preparing a lentivirus destination vector for use in preparation of the factor-encoding libraries, genes cloned into the pCRTM8/GW/TOPO® Gateway entry vector were alternatively transferred using site specific recombination mediated by LR Clonase II (Invitrogen) into a piggyBAC destination vector.

The factors represented in the libraries (and their source organism) are shown in Table 1. Full-length coding sequences for each factor are provided in the Sequence Listing. Nucleic acids encoding Tbx5 (SEQ ID NO:6), Gata4 (SEQ ID NO:8), T (SEQ ID NO:3), Gata6 (SEQ ID NO:9), Mesp2 (SEQ ID NO:5), Nkx2.5 (SEQ ID NO:2), Isl1 (SEQ ID NO:7), Tbx20 (SEQ ID NO:11), Hand1 (SEQ ID NO:12), Hand2 (SEQ ID NO:13), Hey2 (SEQ ID NO:16), Tbx18 (SEQ ID NO:1), Tip60 (SEQ ID NO:18), Oct4 (SEQ ID NO:19), Klf4 (SEQ ID NO:20), L-myc (SEQ ID NO:21), Sox2 (SEQ ID NO:22) were obtained from a mouse embryoid body cDNA library. Human Baf60c DNA (SEQ ID NO:15) was obtained from Addgene Plasmid #21036. Human Mesp1 DNA (SEQ ID NO:4) was obtained in a vector from Michael Kyba at University of Minnesota. Human Mef2c (SEQ ID NO:14) and SRF DNA (SEQ ID NO:17) was obtained in vectors from Youngsook Lee at University of Wisconsin-Madison. Human Irx4 (SEQ ID NO:10) was obtained in a vector from Dr Gary Lyons at University of Wisconsin-Madison.

Production of Lentivirus Particles

The lentiviral expression library vectors were transfected into HEK 293 TN cells (SBI). Briefly, one day before transfection, 4.5×10⁶ cells were plated in a 10 cm dish. Transfections included 7 ug of lentiviral library vectors, 10 μg psPAX2 (Addgene plasmid #12260—packaging), 5 μg pMD2.G (Addgene plasmid #12259—envelope) and Lipofectamine 2000 (Invitrogen) (1:2 ratio). The transfected cells were incubated for 15-16 hours in transfection medium (Lipofectamine-DNA complexes in 2 ml OPTI-MEM medium and 3 ml fibroblast medium (DMEM, 10% FBS, 1% NEAA, 1% L-glutamine and 1% Pen/strep)), which was then replaced with 5 ml of fibroblast medium. After 48-52 hours in fibroblast medium, supernatant containing lentivirus particles was collected, filtered (Millipore 0.45 μM) and frozen at −80° C.

Isolation of Primary Fibroblasts

Adult cardiac- and lung fibroblasts were separately obtained for use in subsequent studies from 1-3 month-old Nkx2.5-EYFP/rtTA double transgenic mice by explant culture. Heart and lung explants were washed with PBS to remove blood cells and were then minced in fibroblast medium (DMEM, 10% FBS, 1% NEAA/L-glutamine/Pen/strep) to about 1 mm³. The minced explants were trypsinized (0.25% trypsin-EDTA) for 10 minutes and were then plated on 0.1% gelatin-coated dishes in fibroblast medium for 10-12 days. Primary fibroblasts that migrated from the explants were harvested, filtered through a 40 μM cell strainers (BD), passaged 1-2 times, and, when not used for experiments right away, frozen in freeze medium (DMEM, 20% FBS, 20% DMSO). No contaminating cTnT⁺ cardiomyocytes were present in the explant culture and the isolated fibroblasts did not express eYFP.

The fibroblasts thus obtained are particularly useful in that doxycycline induces expression of nucleic acid that encodes factors and agents introduced using the lentiviral vectors. Moreover, yellow fluorescent protein (YFP) reporter is expressed only in cells generated in the methods that correspond to cells present in a developing mouse heart at between E7.75-E10.5 during embryogenesis. The developmentally restricted Nkx2.5-EYFP reporter identifies early CPCs, but it is inactive during later stages of cardiac development (E11 onwards) and in the adult heart. The Nkx2.5-eYFP/rtTA mice were obtained by mating male Nkx2.5-eYFP transgenic mice (provided by Dr. Daniel Garry, University of Minnesota and described in Masino et al., Circulation Research 95(4):389-397 (2004), incorporated herein by reference as if set forth in its entirety) with female B6.Cg-Gt(ROSA)26Sortm1(rtTA*M2)Jae/J mice (Jackson Labs) that are homozygous for reverse tetracycline-controlled transactivator rtTA. The male parent Nkx2.5-eYFP mice contain a transgenic 6.6 kb enhancer fragment upstream of Nkx 2.5.

Lentiviral Infection of Primary Fibroblasts and Differentiation to iCPC

One or two days before infection, the primary fibroblasts were seeded in a gelatinized 12 well plate at density of 50,000 cells/well. Immediately before infection, lentivirus supernatants obtained after transfection with vectors of a lentivirus expression library were thawed in 37° C. water bath. The seeded cells were then fed with lentivirus infection media (lentivirus-vector-containing supernatant supplemented with 8 μg/ml Polybrene (Sigma)) to infect the fibroblasts. Lentivirus infection was continued for 48 hours, after which the medium was changed to iCPC induction medium (DMEM, 10% FBS, 1% NEAA, 1% L-glutamine, 1% Pen/strep, 4 μg/ml doxycycline (Sigma), 2.5 μM BIO (Cayman Chemical), 10³ units/ml LIF (Millipore), until cells were reprogrammed by direct lineage reprogramming (i.e., without passing through a pluripotent cell stage). Reprogrammed cells might not take up copies of, or express, every factor in each set and different subsets of factors in a set might independently support reprogramming.

After reprogramming was achieved, and after one passage in iCPC induction medium, iCPC were maintained in iCPC maintenance medium (iCPC induction medium without doxycycline). iCPC were differentiated into cardiac lineage cells, by aggregating the iCPC in 24-well, low attachment plates (Corning) for 2-6 days in cardiac differentiation medium (fibroblast medium, 5 μM IWP4 (Stemgent), 50 ng/ml BMP4 (RD Systems), 10 ng/ml VEGF (RD Systems), 30 ng/ml bFGF (RD Systems) and then plating the aggregates in cardiac differentiation medium. After 2-3 more days, the aggregates where then plated on gelatin-coated dishes and cultured in fibroblast medium containing 1% serum for 10-50 days.

Immunocytochemistry for Detecting Cardiac-Related Markers

Cells were fixed in methanol free formaldehyde (4%) for 12 minutes at room temperature and then permeabilized with 0.1% Triton X for 6 minutes at room temperature and blocked in 2% serum (Goat or Donkey), 5% BSA in PBS for 1 hour at room temperature. Primary antibodies were incubated in blocking buffer containing 0.1% Triton X at 4° C. overnight. Secondary antibodies were incubated in blocking buffer containing 0.1% Triton X for 2 hours at room temperature.

Primary antibodies used and their respective dilutions were—cTnT (Thermo Scientific—1:200), MF20 (Iowa hybridoma bank—1:10), Alpha actinin (Sigma—1:250), Cardiac actin (Sigma—1:400), CD31 (BD Pharmingen—1:400), Smooth Muscle—Myosin Heavy Chain (SM-MHC, Biomedical Technologies—1:250), Nkx2.5 (RD Systems—1:100), Isl1 (RD Systems—1:100), Gata4 (Santa Cruz—1:200), Irx4 (Abgent—undiluted supernatant).

Quantitative RT-PCR

Total RNA was isolated from cells using RNAqueous® Kit (Invitrogen). Reverse transcription was performed using iScript™ Reverse Transcription Supermix (Bio-Rad). qRT-PCR was performed using CFX96™ Real Time PCR Detection System (Bio-Rad) using SsoFast™ EvaGreen Supermix (Bio-Rad). MIQE guidelines were followed in designing qPCR experiments. mRNA levels were normalized by comparison to β-actin (Δ CT) and data are presented as fold change with respect to expression in control fibroblasts (ΔΔ CT).

RNA-Seq and Bioinformatics Analysis

RNA was extracted as above from AC Fibs derived iCPCs either at low passage (1-3) or high passage (8-10). Uninfected AC Fibs were used as control. RNAseq was performed using HiSeq 2500 (Illumina) in duplicates from independent biological samples. Sequencer outputs were processed using CASAVA-1.8.2 (Illumina), and each sample's reads were processed using RSEM version 1.2.3 to obtain expression measures for genes. The percentage of reads that mapped to the RefSeq mm09 reference transcriptome ranged from 79% to 86%. Differential analysis was done using EBSeq version 1.5.3. The EBSeq input dataset contained un-normalized expected count values for all genes as output from RSEM for each sample paired with another (sequence-independent) with condition strings as represented in Table 1 below along with the size factors calculated by median normalization (MedianNorm function within the EBSeq package). Additional input parameters to EBSeq (specifically the EBTest function) specified five total iterations were to be run (maxround=5), genes with similar means were to be grouped into 1000 bins (NumBin=1000), no pooling was to be used (Pool=F), transcript variances with mean less than a variance cutoff of 10-10 (ApproxVal=10{circumflex over ( )}-10) were approximated as the mean divided by (1-10-10), all model parameters (Alpha, Beta, PInput, RInput) were null so that all probabilities were estimated from the data, initial candidate genes for differential expression were taken from the 25%-75% quantile (PoolLower=0.25, PoolUpper=0.75), and transcripts with all zero were to be removed from the dataset (Qtrm=0.99, QtrmCut=0). The targeted false discovery rate for each run was 0.05. Transcripts per million values were used for all calculations. STRING database was used for GO analysis (Franceschini et al., 2013). The targeted false discovery rate (FDR) used for each run of EBSeq was 0.05. Transcripts per million (TPM) values were used for calculations throughout this study.

TABLE 1 EBSeq Input Dataset Condition String Size Factors EBSeq Run Samples (Same Order as in ‘Samples’) (Same Order) 1 1 and 4 “Control, Psg1” 1, 1 2 4 and 6 “Psg1, Psg5” 0.973, 1.028 3 1 and 6 “Control, Psg5” 0.960, 1.042

Ca²⁺ Imaging

Cells were loaded with Rhod-2, AM (Invitrogen) for 20 mins at 37° C. in fibroblast medium, then washed and incubated for additional 30 mins at 37° C. to allow for deesterification of the dye. Rhod-2 loaded cells were analyzed by Nikon epifluorescence microscope with NIS elements software.

Embryo Injections, Immunostaining, and Imaging

Cardiac crescent stage mouse embryos were obtained by timed matings. iCPCs were infected with a GFP lentivirus (Addgene #17448) to trace cells in vivo. Approximately 200-500 iCPCs were introduced into the cardiac crescent of dissected mouse embryos in dissection medium via a mouth-held glass capillary (˜20 μm opening). Operated and stage-matched unoperated embryo samples were then placed into whole embryo culture medium (Downs, Methods in Molecular Medicine 121:241-272 (2006)), and cultured for 24 or 48 hours, with a change to fresh gas- and temperature-equilibrated culture medium at the end of 24 hours for those embryos continuing on for 48 hours. At the end of the culture period, embryos were scored for a variety of parameters, including heartbeat, yolk sac circulation, morphology, and imaged using a Nikon epifluorescence microscope to determine the location of injected GFP cells. Embryos were then fixed with 4% PFA. Immunofluorescence of whole mount embryos was done as previously described by (Nelson et al., Developmental Dynamics 243:381-92 (2014)) and imaging was performed using a custom built multi-photon microscope. Imaris software (Bitplane) was used to make 3D reconstructions.

Statistical Analysis

Differences between groups were tested for statistical significance using ANOVA or for comparison of two groups, Student's t-test. p values of <0.05 were regarded as significant.

Results

Generating and Testing Defined Factor Libraries

A first defined factor library prepared as described above encoded 22 factors (T, Mesp1, Mesp2, Tbx5, Tbx20, Isl1, Gata4, Gata6, Irx4, Nkx2.5, Hand1, Hand2, Tbx20, Tbx18, Tip60, Baf60c, SRF, Hey2, Oct4, Klf4, Sox2, L-myc), including early cardiac transcription factors (expressed during late primitive streak to cardiac crescent stage), late cardiac transcription factors (expressed during heart tube to chamber formation stage), cardiac chromatin remodeling agents, and reprogramming factors employed in reprogramming somatic cells to induced pluripotent cells (iPSC).

Screening for Cardiac Progenitor Cell Inducing Factors

At the outset, the operability, transcription/translation efficiency, and doxycycline regulation of the lentivirus expression system after delivery into fibroblasts was tested and confirmed. Fibroblast cells were infected with a lentiviral vector containing the Green Fluorescent Protein (GFP) gene. In the absence of induction with doxycycline, no GFP expression (evidenced by fluorescence) was observed. In contrast, 24 hours after exposure to doxycycline, 90-95% of cells showed bright GFP fluorescence. One week after doxycycline was withdrawn, no GFP expression was observed. After infection of fibroblasts with individual factors provided in lentiviral vectors, efficient transcription was confirmed by RT-PCR and translation was confirmed by immunocytochemistry.

Uninfected adult cardiac fibroblasts (AC Fibs) did not express Enhanced Yellow Fluorescent Protein (EYFP) and senesced after 3-4 passages (FIG. 3A). As a first test of the dox-induciblelibrary for reprogramming, AC Fibs were infected with iPSC factors. Following these infections, dox treatment produced proliferative cells that formed EYFP-iPSC colonies (FIG. 3B).

Uninfected adult cardiac fibroblasts (AC Fibs) were then infected with iCM factors Gata4 (G), Mesp1 (M), and Tbx5 (T). Even after extended dox induction (6 weeks), we did not observe contracting cells or EYFP+ cells. However, neonatal cardiac fibroblasts infected with iCM factors reprogrammed into spontaneously contracting EYFP-iCMs after 4 weeks of dox treatment (FIG. 3C). These results demonstrate dox-inducible reprogramming with the described vector system. Furthermore, the Nkx2.5-EYFP reporter is not activated during iPSC or iCM reprogramming.

Next, AC Fibs were infected with a library of lentiviruses containing all 22 factors, or GFP only, or iPSC factors only (negative control) and were then induced with doxycycline. After induction via dox treatment, cultures were monitored for appearance of EYFP⁺ cells. Infection of AC Fibs with a mixture of lentiviruses containing all 22 factors resulted in a small number of EYFP⁺ proliferative colonies only after dox treatment (FIG. 3D).

When iPSC factors were subtracted from the 22-factor expression library (leaving 18 cardiac factors), proliferative EYFP+ cells were observed three weeks after dox treatment (FIG. 3D). Reasoning that factors expressed early in cardiac development might have the highest potential to reprogram fibroblasts into iCPCs, 11 early cardiac factors (Mesp1, Mesp2, Gata4, Gata6, Baf60c, SRF, Isl1, Nkx2.5, Irx4, Tbx5, Tbx20) were selected for AC Fibs infection. Infection with the 11-factor expression library gave rise to proliferative EYFP⁺ cells (FIG. 1B).

The time course of appearance of EYFP⁺ cells upon infection with 11 factors was analyzed. Single EYFP⁺ cells were detected as early as day 4 after dox treatment. By 3 weeks after dox treatment, these EYFP⁺ cells developed into two-dimensional, highly proliferative colonies of EYFP⁺ cells that lost their parental fibroblast morphology and exhibited a high nuclear-cytoplasmic ratio (FIGS. 1C-D). Infection with 11 factors reproducibly gave rise to EYFP⁺ proliferative colonies (4 colonies/50,000 cells; efficiency 0.008%) (FIGS. 1E-F). We manually isolated these EYFP⁺ colonies and tried to expand them by splitting. However, cells lost EYFP expression and senesced after 3-5 passages in the ‘dox only’ culture condition (FIG. 1G).

Wnt and JAK/STAT Signaling Promotes Proliferative Reprogrammed Cells

The overexpression of cardiac factors alone, even though sufficient to produce EYFP+ colonies, was insufficient for maintaining EYFP+ cells in a proliferative, reprogrammed state, suggest that additional signaling cues might be necessary for maintenance of iCPCs. Canonical Wnt signaling is critical for proliferation of CPCs (Cao et al., Cell Res. 23:1119-32 (2013); Kwon et al., PNAS 104:10894-10899 (2007); Qyang et al., Cell Stem Cell 1:165-79 (2007)) and JAK/STAT signaling is important for normal cardiogenesis (Foshay et al., Stem Cells 23:530-543 (2005); Snyder et al., J. Biol. Chem. 285: 23639-23646 (2010)). The effect of supplementing reprogramming medium with BIO (canonical Wnt activator) and/or LIF (JAK/STAT activator) on reprogramming efficiency and the ability of EYFP+ cells to maintain a proliferative state was tested. Surprisingly, addition of LIF alone inhibited the generation of EYFP+ cells and colony formation. Addition of BIO alone resulted in a similar reprogramming efficiency as dox only; however, the EYFP+ cells became spindle-like upon passaging and were not highly proliferative. The LIF+BIO combination produced the brightest EYFP+ cells and the EYFP+ cells were robustly expandable (FIGS. 3E-G). Hence, both LIF and BIO are included in our iCPC maintenance culture medium—“iCPC induction medium.” Infection of the 11-factor library followed by culture in iCPC induction medium produced 6-9 EYFP+ colonies (per 50,000 starting cells) that were continuously expanded on splitting (0.013% reprogramming efficiency). To determine whether LIF+BIO was necessary for initial reprogramming, we tested whether EYFP+ colonies generated by the dox only condition could be expanded by addition of LIF+BIO later during passaging. We observed that addition of LIF+BIO starting at passage 1 allowed for robust expansion of dox only EYFP+ cells, indicating that the impact of LIF+BIO was more on the maintenance of the reprogrammed state than on initiation of reprogramming.

11-Factors Stably Reprogram Adult Cardiac Fibroblasts into Cardiac Mesodermrestricted iCPCs

To determine whether continued forced expression of 11-factors (Mesp1, Mesp2, Gata4, Gata6, Baf60c, SRF, Isl1, Nkx2.5, Irx4, Tbx5, Tbx20) was required to maintain the iCPC state, we withdrew dox from the iCPC induction medium (iCPC maintenance medium) after 2 passages and assessed whether EYFP+ cells remained proliferative. Cells maintained EYFP expression as well as their proliferative ability for over 30 passages (FIG. 5A). The EYFP+ cells continued to reduce in size during the initial passage until passages 2-3, at which point they reached a steady state after which their morphology remained unchanged during further passaging. The population doubling time of iCPCs that had been passaged in iCPC maintenance medium for 10 and 20 passages was determined. Both passage 10 and passage 20 iCPCs had similar population doubling time of about 30 hours, which was significantly less than AC Fibs (FIG. 5B). These results suggest that iCPCs were stably reprogrammed and maintained their epigenetic state in the presence of LIF+BIO and without exogenous induction of cardiac factors by dox.

Quantitative PCR (qPCR) analysis of iCPCs revealed upregulation of key CPC transcription factors including Nkx2.5, Tbx5, Mef2c, Mesp1, Tbx20, and Irx4 accompanied by down regulation of the fibroblast-specific gene Fsp1 (FIG. 4C). These data indicate that iCPCs initiated the cardiac epigenetic program at the expense of the fibroblast program, a hallmark of lineage reprogramming. Next, we performed immunostaining for CPC transcription factors (TFs). In contrast to AC Fibs, which did not immunolabel for Nkx2.5, Gata4 or Irx4 (data not shown), iCPCs exhibited nuclear localization of these TFs that remained constant across passages 5-25 (FIG. 5D). Flow cytometry demonstrated that greater than 95% of the iCPCs expressed Nkx2.5, Gata4, and Irx4 (FIG. 5E). Further, we assessed whether iCPCs expressed cell surface markers associated with CPCs (Kattman et al., Cell Stem Cell 8:228-240 (2011); Nelson et al., Dev. Dynamics 243:381-92 (2008)). Flow cytometry analysis revealed that iCPCs homogenously expressed Cxcr4; however, only a fraction of iCPCs expressed Flk1, Pdgfr-α, or cKit (FIG. 5F). We found no protein expression for pluripotency (Oct4) or cardiac lineage differentiation markers (α-MHC, SM-MHC, CD31) even after extensive passaging (data not shown).

To characterize the transcriptome of iCPCs, we performed RNA-seq analysis on early passage (1-3) as well as late passage (8-10) iCPCs and compared with uninfected AC Fibs. We found that genes involved in cardiovascular development including TFs (Tbx3, Hes1, Prrx1, Foxa2, Gata4/6, Meis1, Gli2), signaling molecules (LIF, Vegfc, Grem1, Fgf2), cell surface markers (cKit, Pdgfr-α, Notch1, Gpc3) and chromatin remodeling genes (Smarcd3, Hdac 2/5/7/10, Jarid2) were increasingly upregulated as iCPCs were passaged. In contrast, fibroblast-specific genes (Postn, Twist2, Thy1) were increasingly downregulated with passaging. Furthermore, CM differentiation markers (Actc1, Myh6, Myl2, Myl7) were not expressed in iCPCs. Interestingly, genes associated with smooth muscle (SM) (Cnn1, Myh11) and endothelial cells (EC) (Pecam1) were upregulated in one early passage replicate. However, these genes were downregulated in late passage iCPCs. Primitive streak genes (Gsc, Mixl1, T) were not detected. Likewise, progenitor genes for endoderm, ectoderm and non-cardiac mesoderm were not expressed. Additionally, Bone Morphogenetic Protein (BMP) (4/6/7) genes that induce cardiac differentiation were also downregulated. Importantly, iCPCs did not express markers of pluripotent stem cells (Pou5f1, Esrrb, Dppa2/3, Lin28a, Sox2); however, we did observe upregulation of Nanog. These data demonstrate that iCPCs are cardiac mesoderm-restricted precursors. Gene Ontology (GO) terms associated with upregulated genes in iCPCs include categories such as “positive regulation of cell proliferation,” “negative regulation of cell differentiation,” and “cardiovascular system development,” whereas terms associated with the downregulated genes include categories such as “cell adhesion,” “cell differentiation,” and “apoptosis” (FIG. 4 ).

iCPCs Differentiate into Cardiomyocytes, Smooth Muscle Cells, and Endothelial Cells

To determine whether iCPCs were capable of differentiation into cardiovascular lineages, iCPCs were aggregated in cardiac differentiation medium. iCPCs maintained EYFP expression in aggregates. However, 20 days after plating, cells lost EYFP expression, suggesting that the iCPCs exited the progenitor state and differentiated (FIGS. 6A-B).

Immunocytochemistry revealed differentiated cells expressing CM (cardiac actin, α-actinin, MLC-2a, MLC-2v, α/β MHC), SM (SM-MHC) or EC (CD31) markers (FIG. 6C). These results suggest that iCPCs were multipotent, capable of differentiating into three types of cardiovascular lineage cells. We evaluated the differentiation potential of passage 5 and 30 iCPCs and observed that multipotency was maintained across passages (data not shown). Among iCPC-differentiated cells, a majority stained positive for CM-markers (80-90%) and only a fraction stained for SM (5-10%) and EC markers (1-5%). Most MLC-2v positive CMs also labeled for MLC-2a, indicating that they were relatively immature.

Even after attaining highly organized sarcomeres following extended culture periods under low serum conditions, the iCPC-derived CMs did not exhibit spontaneous contractions. We reasoned that co-culturing iCPC-CMs with mESC-derived CMs may provide additional mechanical, electrical and paracrine stimulation to induce further maturation and contraction. Co-culturing with rat CMs has been previously shown to induce contraction in iCMs (Wada et al., 2013). Hence, we infected iCPC-CMs with a constitutive GFP expressing lentivirus to identify reprogrammed cells and co-cultured them with mESC-derived CMs expressing td-tomato. We did not detect cells that coexpressed both GFP and td-tomato (FIG. 6D), suggesting that cell fusion between iCPC-CMs and mESC-CMs was unlikely. We immunostained the co-cultured cells for CM markers as well as GFP and noticed that GFP iCPC-CMs and GFP-mESC-CMs both stained positive for CM markers and grew side by side as monolayers (data not shown). Moreover, immunostaining for Cx43 revealed that iCPC-CMs developed abundant gap junctions with both mESC-CMs as well as other iCPC-CMs (FIG. 6E). After 10-14 days of co-culturing, 5-10% of iCPC-CMs started synchronously contracting with mESC-CMs. The contracting iCPC-CMs also showed spontaneous calcium transients that were similar to those in mESC-CMs in frequency and amplitude (FIGS. 6F-G).

iCPCs Differentiate into Cardiomyocytes when Injected into the Cardiac Crescent of Mouse Embryos

After demonstrating the cardiovascular potency of iCPCs in vitro, we wanted to assess their potency in vivo. Hence, we injected iCPCs into the cardiac crescent of mouse conceptuses (headfold 4-6 somite pairs stage). The rich cardiogenic signaling environment present in the crescent promotes differentiation of embryonic CPCs (Abu-Issa and Kirby, Annu Rev Cell Dev Biol 23:45-68 (2007)). iCPCs were first infected with a constitutive GFP expressing lentivirus to track their progeny post-injection. We injected 200-500 iCPCs each in a total of 20 embryos in two separate experiments and cultured whole operated and unoperated control conceptuses for 24 or 48 hrs. During this culture period, the cardiac mesoderm undergoes a morphogenic shift to develop into a beating heart tube. We performed live imaging on injected embryos to determine the location of the GFP cells. In 3/20 embryos no GFP cells were detected, possibly due to leakage of cells out of the injection site during the injection. In 15/17 of the remaining embryos (88%), GFP cells localized exclusively to the developing heart and appeared to beat along with the endogenous CMs (FIGS. 7A-B). The presence of GFP cells in the heart tube suggests that iCPCs were able to respond to cardiac-morphogenetic signaling in the developing embryo and localize/differentiate along with host CPCs to the beating heart tube. To assess whether the iCPC-derived cells could integrate with host cells, some of the injected embryos were sectioned and immunostained with a GFP antibody. We observed that iCPC-derived cells (brown color) integrated with host cells within the heart tube (FIG. 7C).

To determine if injected iCPCs differentiated into CMs in vivo, whole mount embryos were co-immunostained for GFP and CM markers. Specimens were imaged as optical sections (1 μm) using multi-photon excitation microscopy, and 3D reconstructions of the z-stack images were performed. In the 24-hr cultured embryos, we detected several GFP cells in the heart tube that co-stained for CM markers such as MLC-2v and cardiac actin. In 24-hr cultured embryo samples the iCPC-derived CMs had an elongated appearance and looked morphologically distinct from the native CMs (FIG. 7D). However, iCPC-derived CMs in the 48-hr cultured embryos had a rounder morphology and appeared similar in shape and size to the native CMs (FIG. 7E). The morphological change (from elongated to round) suggests that the iCPC-CMs continue to mature in vivo during the extended culture. iCPC-CMs were observed in developing atria, ventricles as well as outflow track, showing no spatial preference within the heart tube.

Although we observed endothelial differentiation from iCPCs in vitro, we were unable to convincingly detect iCPC-derived CD31 cells in vivo. Due to the limited endothelial potency of iCPCs (only 1-5% detected during in vitro differentiation), we may have missed rare CD31⁺ cells within embryos. A limitation of the whole embryo culture technique used here is that it was specifically designed for early gastrulae (Lawson et al., Development 113:891-911 (1991)), that culture from ˜E7.75 to E10.5. The culture period cannot be extended beyond E10.5 as the embryo becomes increasingly dependent upon formation of a chorio-allantoic placenta, and interaction with its mother (Cockroft, Postimplantation Mammalian Embryos: A Practical Approach (Eds. A. J. Copp and D. L. Cockroft). IRL Press: Oxford. Pp. 15-40 (1990)). Hence, we were unable to assay embryos for smooth muscle as the onset of smooth muscle differentiation is after E10.5 (Madsen et al., Circ. Res. 82:908-917 (1998); Miano et al., Circ. Res. 75:803-12 (1994)), which exceeded our whole embryo culture duration (E7.75-E9.75).

Five Factors Sufficient to Reprogram Adult Cardiac Fibroblasts to iCPCs

We wanted to determine whether iCPCs could be obtained from adult cardiac fibroblasts using a subset of the 11 factors. Initially, we infected AC Fibs with a combination of three cardiac factors, Gata4 (G), Mesp1 (M), and Tbx5 (T), and cultured them in iCPC induction medium, but we did not observe emergence of any EYFP+ colonies for up to 4 weeks. Therefore, we tested whether addition of Nkx2.5 to Gata4 (G), Mesp1 (M), and Tbx5 (T) (MTGN) could induce formation of EYFP+ colonies. The four factors (MTGN) followed by culture in iCPC induction medium, produced EYFP+ colonies after 3 weeks. Although these EYFP+ cells proliferated for the first two passages, their proliferative ability as well as EYFP expression progressively declined with subsequent passaging (FIG. 8A). This indicated that MTGN induced partial reprogramming and was insufficient to epigenetically stabilize cells in the iCPC state. Hence, we tested if the addition of Baf60c, (a chromatin remodeling agent) to MTGN (MTGNB) could facilitate stable reprogramming to iCPCs. Indeed, infection with 5 factors (MTGNB) reproducibly gave rise to EYFP+ colonies (˜7 colonies/50,000 cells), which could be stably expanded in iCPC maintenance medium (without dox) for at least 20 passages (FIGS. 8A-C). A majority of 5-factor reprogrammed iCPCs showed nuclear localization of CPC TFs Irx4 (78%), Gata4 (84%) and Nkx2.5 (85%) as well as expressed CPC associated cell surface markers (Cxcr4, Flk1, Pdgfr-α and cKit) (FIGS. 8D-F). Also, upon re-aggregation in cardiac differentiation medium followed by low serum culture, 5-factor iCPCs differentiated into CMs (cardiac actin, α-actinin, MLC-2a, MLC-2v, α/β MHC), SMs (SM-MHC) and ECs (CD31) indicating their multipotency (FIG. 8G). 5-factor iCPCs were comparable to 11-factors iCPCs in morphology, EYFP expression, proliferative ability, staining for CPC markers, as well as cardiac lineage potency.

11/5-Factors Stably Reprogram Adult Lung and Tail-Tip Fibroblasts to iCPCs

To determine whether iCPCs could be reprogramed from non-cardiac sources of fibroblasts, we isolated adult lung fibroblasts (AL Fibs) and adult tail-tip fibroblasts (AT Fibs) from Nkx2.5-EYFP/rtTA transgenic mice. Both AL Fibs and AT Fibs stained negative for CPC TFs as well as cardiac lineage differentiation markers and had no EYFP expression. We infected AL Fibs and AT Fibs with either 11 or 5 factors and cultured them in iCPC induction medium. AL Fibs infected with 11 factors or 5 factors produced 9 EYFP⁺ colonies (per 50,000 cells) (FIG. 9A). AT Fibs infected with 11 factors or 5 factors produced 5 or 4 EYFP⁺ colonies (per 50,000 cells), respectively (FIG. 10A). EYFP+ cells reprogrammed from both lung and tail-tip fibroblasts were stably expanded in iCPC maintenance medium for at least 10- and 7-passages, respectively, stained positive for CPC markers, and differentiated into CMs, SMs and ECs (FIGS. 9B-G and FIGS. 10 -B-G) indicating that adult fibroblasts from diverse tissues of origin can be stably reprogrammed into proliferative and multipotent iCPCs.

11-Factor Set Reprograms Genetically Unmodified Human Fibroblasts into Morphologically Distinct and Highly Proliferative iCPCs

We wanted to determine whether iCPC reprogramming could be recapitulated using human cells. For the initial experiments we chose human fetal lung fibroblasts cells (IMR 90). IMR 90 fibroblasts were one of the first human cells that were reprogrammed to iPSC state, and their ability to undergo reprogramming is documented. Also, transitioning direct reprogramming technologies, which were first optimized using mouse cells, to human cells has been challenging. Hence, we reasoned that fetal fibroblasts, which are more amenable to transdifferentiation than adult cells, may be suitable for an initial demonstration.

IMR 90 fibroblasts were cultured in fibroblast medium (described earlier) and showed spindle-like, elongated morphology (FIG. 11A). First, they were infected with a rtTA lentivirus to allow for doxycycline inducible transgene expression (IMR-rtTA). As a control to test dox inducible gene expression, IMR-rtTA cells were infected with a GFP lentivirus and induced with dox. Twenty-four hours after dox induction, 80-90% of the infected cells showed bright GFP expression (FIG. 11B). These cells were cultured in dox containing medium for 2-3 weeks. Even though the cells continued to express GFP, the morphology of the cells remained unchanged following infection with GFP lentivirus and extended culture (FIG. 11C). Next we infected IMR-rtTA cells with 11 cardiac factors and induced with dox. We noticed proliferative and morphologically distinct cells 2 weeks after dox induction. By day 24, these cells developed into colonies of highly proliferative cells (FIG. 11D). Unlike mouse fibroblasts, which had an Nkx 2.5-EYFP cardiac reporter, the IMR 90 cells were not genetically engineered. Hence, we relied on the dramatic morphological change that fibroblasts undergo during iCPC reprogramming as a marker to identify cells undergoing transdifferentiation. Based on the appearance of morphologically distinct, proliferative colonies iCPC reprogramming efficiency was calculated to be 0.02%.

Human iCPCs Express CPC TFs and Differentiate into Cardiomyocytes, Smooth Muscle Cells and Endothelial Cells

iCPCs maintained proliferative ability and were expanded for 2-3 passages under dox induction. Next, we performed immunostaining for CPC TFs such as Irx4, Mesp1, Nkx 2.5, and Tbx5 (dox was withdrawn for 1 week prior to immunostaining). A majority of cells exhibited nuclear localization of these TFs (FIG. 12A) indicating that the morphologically distinct, proliferative cells were indeed iCPCs.

To determine whether iCPCs were capable of differentiation into cardiovascular lineages, iCPCs were aggregated in cardiac differentiation medium and differentiated as previously described. Immunocytochemistry revealed differentiated cells expressing CM (cardiac actin, α-actinin, MLC-2a, MLC-2v, α/β MHC), SM (SM-MHC) or EC (CD31) markers (FIG. 12B). These results suggest that human iCPCs were multipotent, capable of differentiating into three types of cardiovascular lineage cells. These data also demonstrate that our iCPC- and cardiomyocyte-differentiation methodologies are successfully recapitulated in human cell types and should be useful for a variety of mammalian species and various somatic cell types. 

1. An isolated induced cardiac progenitor cell (iCPC) capable of differentiating into cardiomyocytes, SM-MHC⁺ smooth muscle cells, and CD31⁺ endothelial cells, wherein the iCPC expresses Mesp1, Baf60c, Nkx2.5, Gata4, and Tbx5, wherein the iCPC is capable of proliferating and remaining multipotent for at least 5 passages in a culture medium comprising an activator of canonical Wnt signaling and an activator of Jak/Stat signaling, and wherein the iCPC is NKx2.5+, Gata4+, Irx4+, Cxcr4+, Oct4−, Mlc-2a−, SM-MHC−, and CD31−.
 2. An in vitro cell culture, comprising: a population of induced cardiac progenitor cells (iCPC) according to claim 1; and a cell culture medium comprising an activator of canonical Wnt signaling in an amount sufficient to maintain proliferation and multipotency of iCPCs in the population for at least 5 passages.
 3. The in vitro cell culture of claim 2, wherein the activator of canonical Wnt signaling comprises one or more of 6-bromoindirubin-3′-oxime (BIO), CHIR 99021, CHIR 98014, BIO-acetoxime, LiCl, SB 216763, SB415286, AR A014418, 1-Azakenpaullone, and Bis-7-indolylmaleimide.
 4. The in vitro cell culture of claim 2, wherein the cell culture medium further comprises an activator of Jak/Stat signaling.
 5. The in vitro cell culture of claim 4, wherein the activator of Jak/Stat signaling comprises an interleukin (IL)-6-related cytokine.
 6. The in vitro cell culture of claim 5, wherein the interleukin (IL)-6-related cytokine is Leukemia Inhibitory Factor (LIF), IL-2, IL-6, IL-11, leptin, and/or ciliary neurotrophic factor (CNTF).
 7. The in vitro cell culture of claim 5, wherein the interleukin (IL)-6-related cytokine is LIF.
 8. An isolated induced cardiac progenitor cell (iCPC) capable of differentiating into cardiomyocytes, SM-MHC⁺ smooth muscle cells, and CD31⁺ endothelial cells, wherein the iCPC expresses Mesp1, Baf60c, Nkx2.5, Gata4, and Tbx5, wherein the iCPC expresses one or more of Mesp2, Gata6, SRF, Isl1, Irx4, and Tbx20, wherein the iCPC is capable of proliferating and remaining multipotent for at least 5 passages in a culture medium comprising an activator of canonical Wnt signaling and an activator of Jak/Stat signaling, and wherein the iCPC is NKx2.5+, Gata4+, Irx4+, Cxcr4+, Oct4−, Mlc-2a−, SM-MHC−, and CD31−. 